A Comparison of the Effects of Teach-Back and Motivational Interviewing on the Adherence to Medical Regimen in Patients with Hypertension

Figures & data

Figure 1 Consort flow diagram.

Table 1 The Teach-Back Training Group Intervention Protocol (in each Session)

Teach-Back Stages	Type of Activity and Objective	Estimated Time
Pretest stage	Open-ended questions are used based on the goals of each meeting.	10 min
Goal setting	Based on the pretest, behavioral goals in each cognitive and psychomotor domain are determined for each client.	5 min
Implementation of training process	The teaching process is performed by taking the following points into account: -Transferring the content and concepts in a simple and transparent way -Emphasis on the key points and repetition -Use of short sentences	10–15 min
Evaluating	If the client answers 75% of the questions correctly, the teaching has been effective Otherwise it continues	10 min
The decision to repeat the above steps is based on the patient’s learning and the designated objectives	Teaching is repeated again according to what the client did not say	5–10 min

Table 2 The Structure of Motivational Interviewing Sessions

Session	Teaching Content
First session	Orientation: Introduction, norms and group processes, facilitating philosophy, training the dimensions of behavioral effects, training the change cycle (performed by following the basics, principles, and techniques of the motivational interview
Second session	Feeling: Trying to know the emotions, training and completion of the dimensions of the effects with emotional dimensions an homework
Third session	Positive and negative dimensions of negative and change: Training the brainstorming on short-term and long-term benefits and losses, training alternatives and supporting self-efficiency
Fourth session	Values and perspective: identifying and prioritizing values, matching the values with behaviors, identifying tempting situations
Fifth session	Summarizing the exercises of previous sessions in the framework of perspective training, start the behavior change program

Table 3 Frequency Distribution and Comparison of Qualitative Demographic Variables Among Patients with Hypertension in Intervention Group 1 (Teach-Back), Group 2 (Motivational Interviewing), and Control Group at Baseline

Qualitative Variable	Variable Level	Intervention Group1 (Teach-Back)		Intervention Group 2 (Motivational Interviewing)		Control Group		Total		Statistical Test*
		Number	Percent	Number	Percent	Number	Percent	Number	Percent	Statistic	P-value
Gender	Male	7	25.9	8	29.6	10	37	25	30.9	0.81	(χ)0.67
	Female	20	74.1	19	70.4	17	63	56	69.1
Marital status	Single	1	3.7	1	3.7	4	14.8	6	7.4	2.66	(F)0.35
	Married	26	96.3	26	96.3	23	85.2	75	92.6
Educational attainment	Under diploma	16	59.3	5	18.5	12	44.4	33	40.7	9.75	(χ)0.06
	Diploma	6	22.2	14	51.9	9	33.4	29	35.8
	Higher than diploma	5	18.5	8	29.6	6	22.2	19	23.5
Living conditions	Alone	2	7.4	1	3.7	4	14.8	7	8.6	1.99	(F)0.49
	With spouse and children	25	92.6	26	96.3	23	85.2	74	91.4
Employment status	Employer	5	18.5	6	22.2	5	18.5	16	19.8	0.27	(χ)0.99
	Self-employed	6	22.2	6	22.2	7	25.9	19	23.5
	Housewife	16	59.3	15	55.6	15	55.6	46	56.7
Supportive coverage status	Insurance	21	77.8	19	70.4	14	51.9	54	66.7	4.3	(χ)0.12
	No insurance	6	22.2	8	29.6	13	48.1	27	33.3
Smoking	Yes	2	7.4	1	3.7	2	7.4	5	6.2	0.61	(F)0.99
	No	25	92.6	26	96.3	25	92.6	76	93.8
Food preparing person	Himself/herself	21	77.8	17	63	17	63	55	67.9	1.81	(χ)0.4
	Spouse or other family members	6	22.2	10	37	10	37	26	32.1

Notes: *Fisher Exact test and Chi square test were used.

Table 4 Comparison of the Groups Adherence to Regimen and its Subscales in Patients with Hypertension at the Beginning

Variable		Group	Mean±SD	Statistical Test*
				Statistic	P-value
Therapeutic Regimen Adherence		Intervention group 1 (teach-back)	2764.4±425.9	0.21	0.81
		Intervention group 2 (motivational interviewing)	2738.2±410.8
		Control group	2809.9±395.5
Subscales of adherence to treatment regimen	Adherence to diet	Intervention group 1 (teach-back)	1892.3±198	0.13	0.88
		Intervention group 2 (motivational interviewing)	1899.1±189.2
		Control group	1919.1±212.4
	Adherence to drug regimen	Intervention group 1 (teach-back)	534.1±98.9	1.95	0.15
		Intervention group 2 (motivational interviewing)	491.9±55
		Control group	507.4±78.7
	Adherence to exercise program	Intervention group 1 (teach-back)	338±321.2	0.15	0.86
		Intervention group 2 (motivational interviewing)	347.2±323.1
		Control group	383.33±312.70

Notes: *One-Way Analysis of Variance test used.

Table 5 Comparing the Groups Adherence to Regimen and its Subscales in Patients with Hypertension Two Months After Intervention

Variable		Group	Mean±SD	Statistical Test*
				Statistic	P-value
Therapeutic Regimen Adherence		Intervention group1 (teach-back)	3674.6±484.3	46.4	0.0001
		Intervention group2 (motivational interviewing)	4087.2±479.2
		Control group	2858.4±466.8
Subscales of adherence to treatment regimen	Adherence to diet	Intervention group1 (teach-back)	2150±164.5	15.6	0.0001
		Intervention group2 (motivational interviewing)	2228.7±214.2
		Control group	1937.3±213.2
	Adherence to drug regimen	Intervention group1 (teach-back)	816.3±101.1	71.4	0.0001
		Intervention group2 (motivational interviewing)	851.1±107.2
		Control group	519.3±126.7
	Adherence to exercise program	Intervention group1 (teach-back)	708.3±371.6	20.6	0.0001
		Intervention group2 (motivational interviewing)	1007.4±335.8
		Control group	401.9±332.4

Notes: *One-Way Analysis of Variance test used.

Table 6 Within-group Comparison of Adherence to Regimen in Patients with Hypertension in Intervention Group Teach-Back, Intervention Group Motivational Interviewing, and Control Group at the Beginning and Two Months After Intervention

Variable	Group	Mean±SD		Paired Difference
		At the Beginning	Two Months after Intervention	Mean±SD	Confidence Interval of 95%		Statistical Test*
					Lower Bound	Upper Bound	Statistic	P-value (two-tailed)
Therapeutic Regimen Adherence	Teach-back	2764.4±425.9	3674.6±484.3	910.3±554	691.1	1129.4	8.5	0.0001
	Motivational interviewing	2738.2±410.8	4087.2±479.2	1349.1±594.8	1113.8	1584.4	11.8	0.0001
	Control	2809.9±395.5	2858.4±466.8	48.5±347.2	−88.8	185.9	0.73	0.47

Notes: *Paired t-test used.